In recent years a research team at Strathclyde Business School has been evaluating the automation of aspects of pharmacy operations that patients may never see. Having looked at acute pharmacy dispensing, both by off-site robotics and on-site dispensing robots, the team has now been asked by the Scottish Government to look at several pilots of new technologies in community pharmacy, examining the potential of automated and semi-automated technologies to improve clinical care. Professor Patricia Findlay, who leads the team, will use her keynote address to the Pharmacy Management Forum in Scotland (30 August) to talk about the lessons learned so far and the challenges that still lie ahead. And she told John Macgill that, in many ways, plugging in a machine is the easy bit.

PF: We often talk about automation as if it is an issue on its own, but what became clear quite quickly with the early technology adopters we engaged with was effective change is as much about organisational challenges as technical. It is as much about saying: 'what are the priorities in our service and how do we reconfigure our processes to make that work?' and 'how do we get the right complement of staff, the right mix of skills and capabilities to make that happen?'

On its own, buying a robot and plugging it in in your pharmacy does not solve any of your challenges until you get that alignment right between the business demands, the healthcare outcomes you are looking for, the capability of the technology you are adopting, the organisational systems you have and the particular configuration of your people that is going to make it all work. You have an awful lot of moving parts, if that's not an unfortunate pun when talking about automation. And the technology is only one part of that.

JM: Is pharmacy, as a sector, any different from any other that you've looked at in terms of the arrival of automation?

PF: My research has led me to spend a number of years looking at broad workplace innovation strategies, some of that focused on small businesses. While there are obvious similarities between the acute and community pharmacy settings we have looked at, there are also interesting similarities between community pharmacies and other small businesses. I think the challenges of identifying, designing and adopting technologies are quite similar across quite a lot of different businesses because part of what you're doing is really thinking properly about your organisation: how does technology fit in and align with what you already have and, crucially, how do you bring people with you.

When you listen to the debate on new technology you often hear either hugely optimistic or hugely pessimistic opinions and predictions. In fact, putting technologies into real organisations is always a bit more complex: the shiny, fabulous new technology that does everything perfectly from day one tends not to be what people experience in the real world. So a long-standing theme of introducing technological change is that success requires people to try to take technological opportunities and align them with the other resources and capabilities within their business.

JM: Is there not a basic premise of this that there are some types of job that can be automated and some that cannot; and perhaps the people who are most highly qualified in a pharmacy team can feel less threatened by automation than others?

PF: I think there is an important distinction to be made here in terms of it whether we're talking about some kinds of job or some kinds of task. If you think about a job as a collection of tasks, there are some tasks that might be more suited to automation. But how you configure tasks into jobs is a matter of choice, and I think that a simple argument about how automation impacts on high-level and low-level jobs isn't especially borne out by the broader evidence.

If you look specifically at pharmacy, in the workplaces we've looked at so far there has often been the option of using technology to eliminate tasks, but whether that eliminates whole jobs is slightly more tricky. The questions becomes: why would you do that, what are the circumstances and constraints that make that the right thing to do and, if you are to do that, what do you do with the people who previously did those tasks? The fact that you decide to automate a task does not determine all of the answers to all of these other questions.

For example, if you look at hospital pharmacy, where we've done a lot of work, you could decide that there will be fewer people in picking and distribution. And there is some evidence that there are benefits to this in reducing the risk of error. But what do you do about the skills and talents and capabilities that resided in the workforce who previously did that work? This then takes us into the debate about whether and how you can take advantage of the knowledge and skills that already exists in pharmacy teams in a way that upskills people to do higher and higher value jobs and, ultimately, have pharmacists more engaged in delivering healthcare. Making these types of choices around technology can help push skills up at every level.

JM: So, automation raises questions about delegation. What are the challenges within pharmacy teams in terms of tasks being allowed to settle at the right level? I am thinking in particular of the community pharmacist who has a huge stake in making everything work smoothly with no errors and, perhaps because the stakes are so high, holding onto tasks and not delegating them to others?

PF: That's a real challenge and it's not just a challenge in pharmacy. I'm not a pharmacist but my understanding, and everything that I hear, is that pharmacists are by orientation, socialisation and professional training risk averse. And we can understand why that is the case when the consequences of errors can be significant. That is the reality of being a pharmacist: you are likely to be quite cautious about what you hand over to other people.

But cautious does not mean that you don't do it. It may mean that you relinquish control of some tasks to allow you to do others in a specific set of circumstances. And that set of circumstances may be that you have become confident about the role that the robot or other type automation is able to play and the outcomes it is delivering. And, at the same time, that you are confident of the skills of the people you delegate to, that they are capable and committed to doing it properly and, at the same time, you have the right checks, balances and safeguards in place.

One of the things that we have seen in pharmacies that have been early adopters of technology is that pharmacists find it quite difficult to give up tasks. But if you get the right skills mix and the right people and you work with them over time, you establish trust relationships and confidence in people's competence. It does takes time. It does not happen overnight. So, if you want, for instance, to delegate to a checking technician, you can go and recruit somebody who has the appropriate qualifications but that does not always mean you then have somebody who can immediately be comfortable in the team and work in synergy from day one. As a leader, you have to create the circumstances where everyone has confidence in the process, where everyone is doing the best, the highest value tasks.

While pharmacists may be risk averse, they are also very motivated to engage in frontline clinical care. And part of the reason for a pharmacist asking themselves how much time they really need to spend doing tasks that can be done by somebody else, is about freeing time to do other significant tasks for which they are best equipped. And that's not just about finding the most resource-efficient allocation of tasks, it also about allowing them to be a frontline clinician.

Professor Patricia Findlay is Director of the Scottish Centre for Employment Research and is Professor of Work and Employment Relations at the Department of Human Resource Management at the University of Strathclyde Business School. She is a keynote speaker at the Pharmacy Management National Forum in Dunblane on 30th August.

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